Healthcare Provider Details

I. General information

NPI: 1396990206
Provider Name (Legal Business Name): JENNIFER ANNE MEADOR-STONE NCCAOM DIPLOMAT LAC.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2008
Last Update Date: 11/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

888 AUTO MALL RD.
BLOOMINGTON IN
47401
US

IV. Provider business mailing address

5610 CRAWFORDSVILLE RD. SUITE 103
INDIANAPOLIS IN
46224
US

V. Phone/Fax

Practice location:
  • Phone: 812-353-2700
  • Fax: 812-353-2701
Mailing address:
  • Phone: 317-240-8009
  • Fax: 317-240-1040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberIN #84000001
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: